机器人辅助腹腔镜与传统腹腔镜关于全子宫切除术在不同体质指数患者中的对比研究

Safety and feasibility of robot-assisted laparoscopic total hysterectomy versus traditional laparoscopic total hysterectomy in patients with different levels of body mass index

摘要:

目的 比较机器人辅助腹腔镜与传统腹腔镜关于全子宫切除术在不同体质指数患者中的安全性及可行性。方法 回顾性收集2016年2月至2021年4月于重庆医科大学附属第一医院接受了机器人辅助腹腔镜全子宫切除术（n=416）和传统腹腔镜全子宫切除术（n=725）患者的病例资料。按照不同等级体质指数（body mass index，BMI）对患者进行分层（非超重、超重和肥胖），比较2组中各BMI亚组间患者的围术期情况、术中及术后并发症。结果 机器人组中超重亚组的手术时间短于传统腹腔镜组［（125.37±50.92） min vs. （135.68±44.55） min］，机器人组中3个BMI亚组的术中出血量均少于传统腹腔镜组［（60.46±45.20） mL vs. （92.88±105.13） mL、（72.01±62.03） mL vs. （115.02±123.38） mL及（65.59±37.92） mL vs. （125.16±96.07） mL］，机器人组中超重亚组和肥胖亚组的首次排气时间均短于传统腹腔镜组［（2.04±0.83） d vs. （2.19±0.63） d和（1.97±0.54） d vs. （2.19±0.54） d］，差异均有统计学意义（P<0.05）。机器人组中各BMI亚组术中及术后总体并发症发生率仍低于腹腔镜组，但差异无统计学意义（P>0.05）。结论 超重和肥胖患者的全子宫切除术，机器人辅助腹腔镜相较于传统腹腔镜在围术期降低并发症等方面有一定优势。

Abstract:

Objective To investigate the safety and feasibility of robot-assisted laparoscopic total hysterectomy versus traditional laparoscopic total hysterectomy in patients with different levels of body mass index.Methods A retrospective analysis was performed for the case data of 416 patients who received robot-assisted laparoscopic total hysterectomy and 725 patients who received traditional laparoscopic total hysterectomy in The First Affiliated Hospital of Chongqing Medical University from February 2016 to April 2021. The patients were stratified according to the different levels of body mass index（non-overweight，overweight，and obese），and the two groups and the subgroups based on body mass index were compared in terms of perioperative conditions and intraoperative and postoperative complications.Results The overweight subgroup in the robot-assisted laparoscopic group had a significantly shorter time of operation than that in the traditional laparoscopic group［（125.37±50.92） min vs. （135.68±44.55） min，P<0.05］，and all three subgroups in the robot-assisted laparoscopic group had significantly lower intraoperative blood loss than those in the traditional laparoscopic group［non-overweight：（60.46±45.20） mL vs. （92.88±105.13） mL，P<0.05；overweight：（72.01±62.03） mL vs. （115.02±123.38） mL，P<0.05； obese：（65.59±37.92） mL vs. （125.16±96.07） mL，P<0.05］. The overweight and obese subgroups in the robot-assisted laparoscopic group had a significantly shorter time to first flatus than those in the traditional laparoscopic group［overweight：（2.04±0.83） d vs. （2.19±0.63） d，P<0.05；obese：（1.97±0.54） vs. （2.19±0.54） d，P<0.05］. All three subgroups in the robot-assisted laparoscopic group had a lower overall incidence rate of intraoperative and postoperative complications than those in the traditional laparoscopic group，but with no statistical significance（P>0.05）.Conclusion As for total hysterectomy in overweight and obese patients，robot-assisted laparoscopy has certain advantages over traditional laparoscopy in reducing perioperative complications.